By Michael Champion
The NHS is the pride of the UK. Providing emergency and long term care free at the point of contact, Aneurin Bevan’s scheme is now in its 68th year. However, the pressures it now faces have increased dramatically. An aging population with increasingly complex healthcare needs has increased the quantity of high quality care required, and thus the demand for competently trained professionals. Coupled with multiple funding crises (including repayment of PFI and necessary maintenance of existing infrastructure) and bureaucratic reorganisations, the ability of the NHS to manage this increased demand has been tested, especially during periods of wider macroeconomic pressure.
This has manifested in a number of ways; most recently, social media has seemingly unified professionals and the public in condemnation of a blunt solution proffered by the Department of Health regarding the aim to reform rostering of junior medical staff. In addition, the increased demands on staff have seen the rise of agencies to cover staffing shortfalls, which may use NHS employed nurses and auxiliaries working to supplement a virtually static state salary. This dramatically increases the cost of service provision.
While there is a necessity to improve provision of care and provide value for money, it should also be recognised that those working within the NHS (whether directly employed or contracted) are performing a public service, and require increased support to facilitate their duties. There are a number of ways in which this could be facilitated.
There should be a movement towards integrated, inter-professional service provision. There are a wide variety of professions which are able to alleviate many of the responsibilities previously reserved for doctors; thus, enabling them to perform their specialist roles of diagnosis and surgical intervention. Utilisation of nurses, pharmacists, therapists, scientists and other allied healthcare professionals can improve patient care through provision of specialist care. To facilitate this, developing roles (such as physician associates) should move towards statutory regulation so that standards in education and continuing fitness to practice may be maintained and developed.
Developing roles should move towards statutory regulation so that standards in education and continuing fitness to practice may be maintained and developed.
Furthermore, the transfer of care provision should be optimised to ensure continuity is maintained. This should include fully utilising social care, as effective social care can improve quality of life, and reduce the burden of treatment required by members of the public. In this respect, social care is an extension of public health, and the role it plays should be respected and integrated further into existing care provision through work between the Department of Health and the Department of Communities and Local Government.
In addition, health and social care professionals should be empowered through comprehensive training to take increased responsibility for patient care. Particularly in professions such as pharmacy, where there is a current surplus of trained professionals compared to attrition within conventional care pathways, upskilling registrants will enable them to identify new avenues of care which can be developed to benefit patient centred care. An example of this is the employment of appropriately trained pharmacists to manage long term medical conditions, thus allowing general practitioners to dedicate more time to diagnosis and treatment initiation, and district nurses to monitoring disease and therapy progression.
Privately contracting work within trusts and CCGs may also prove helpful. Whilst the question of frontline service provision by private contractors will not be countenanced by many following the failure of Hinchingbrooke NHS Trust’s administration by Circle Group, outsourcing responsibilities that are not directly patient facing (such as catering and laundry) can drive down costs, and focus the Trust’s Executive on providing top quality, patient centred care.
Especially given macroeconomic pressures, evidence based therapy should be used. When funds are scarce, there is little justification for funding a therapy with a poor burden of quality evidence, such as homeopathy, when money could otherwise be used to effectively treat other patients. This approach would not only require recalibration by practitioners that have previously advocated these treatments, but also those predisposed to consider “conventional” therapies as the only appropriate treatment.
When funds are scarce, there is little justification for funding a therapy with a poor burden of quality evidence, such as homeopathy.
Finally, there must be mutual respect between the employees of the NHS and those deciding on funding. Whilst partially expanded on earlier, this respect should also extend to negotiations between stakeholders so that consensus and compromise may be sought in pursuit of the greatest benefits for the greatest number of patients. Sudden and irrevocable cessation of dialogue prevents compromise being sought and furthers any mistrust or ill feeling between parties, as has been seen in the negotiations surrounding the junior doctor’s contract on both sides of the argument.
Ultimately, the NHS is undergoing seismic changes as technological and transformative changes are embraced. In order that patients are appropriately placed at the centre of the NHS, a synergistic approach is needed by all key stakeholders during these difficult times to bring about a golden age for patient care.